The treatment of pain in a completely objective way has been hampered by the lack of means to measure pain. Usually when a patient complains of pain, physicians attempt to determine the nature of pain by asking the patient to first describe the pain (that is, sharp, dull, aching, piercing, burning etc.). Then an attempt is made to determine the severity by asking the patient if it was severe, moderate or mild. Some of the other characteristics, such as accompanying symptoms like sweating, palpitations (fast or irregular heart beats) fainting sensation etc or radiation from the focus of pain to a distant area or aggravation of pain by deep breathing, movements of body parts and relief obtained by various maneuvers, such as rubbing, local application of pressure, heat or cold are determined. With this data, in the context of all the other features of the illness, a determination is made as to the most appropriate treatment, including the type of pain relief medications. Such treatment is at best empiric and can not only fail but occasionally lead to many unwanted side effects. In some patients who complain of unusual pain or who feigns pain the whole treatment may fail or at least delay relief by many days or weeks. If one considers chronically painful conditions such as arthritis, back pain, headache, migraine or abdominal pain from various causes, one has to come up with appropriate adjustment in both the doses and, periodically, change in medications. Thus, some form of objective evaluation of pain is sorely required.
Some scientists have attempted to measure pain by various means. Most of such measures have included some form of inducing pain in another part of the body and asking the patient to grade their pain by comparison. This means of determining the severity of pain is impractical for repeated use and will be poorly tolerated by patients. If one considers the fact that the patient is already in pain, such measures to quantitate pain is downright barbaric. It is for this reason that an object of this invention is to achieve the same or better results by relieving pain rather than inducing more pain!
It is common experience that if cold temperature is applied to the part of the body that is painful, that is by applying ice cubes or ice cold water, most of the pain can be relieved quickly. How this is achieved is not completely understood but evidently the nerve endings and the pain sensing organs are "numbed" temporarily. The current invention makes use of this phenomenon to actually quantitate pain. It is anticipated that the reduction in temperature that is required to control pain will depend on the severity of pain, regardless of its cause.
Thus, an apparatus with a suitable probe that is cooled through a whole range of temperatures is required. If such a probe also measures the temperature of the part of the skin that is thus cooled, a system is in place for measuring pain.
The system will operate in the following manner: the operator selects a suitable tip or probe attached at the end of the apparatus and applies the probe over the area where the patient is experiencing pain. Then the temperature at the probe is gradually lowered after the patient is instructed to indicate immediately when pain relief is obtained. The instrument is then held at that temperature and skin surface temperature is measured. Either the change in temperature from room temperature or the actual skin surface temperature required to control pain is recorded and constitutes the degree of pain. One could easily assign a unit for this measurement. The term "DOL" is proposed for this unit (as "dolor" means pain in Latin). Some experimentation will then determine the degree of pain in various painful conditions in terms of "DOLs" and will serve as the standard against which patients will be assessed. Then one could take this information to its next logical step, that of determining the appropriate analgesic (pain relieving medication) or other means. Thus, guesswork is totally eliminated from the business of relieving pain. A useful by-product of this system of measuring pain is the categorization of the different types of pain into grades and in detecting when pain is not actually felt but imagined or faked.
Cryosurgical equipment (these are used to freeze lesions on skin or accessible other body parts for treatment) are in existence already and some of these already have all the ingredients of the sort of apparatus proposed. However, so far, they have only been used to remove diseased parts (e.g.: warts from skin or abnormal tissue from cervix of the uterus) and not for measuring pain. For this purpose the equipments may need gauges with graduations straddling the freezing point but none much below that value, unlike the usual cryosurgical equipments. It is envisioned that such pain measuring devices will become commonplace in headache/migraine clinics, rheumatologists' and orthopedic surgeons' offices, chiropractors' and dentists' offices and the like. Then one could confidently tell patients that their pain is of "this degree" and it needs "this group of medicine" for relief or its need for admission to hospital and/or i.v. narcotics etc.